What is included in inpatient care for venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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In general, inpatient care requires the administration and continuation of intravenous (IV) or SC anticoagulants, with an oral anticoagulant (the coumarin derivative warfarin sodium) started within 72 hours of the SC anticoagulant or, if IV heparin is being given, once the aPTT is therapeutic (1.5-2 times baseline).

The reason that the oral administration of warfarin sodium is started after anticoagulation with SC or IV anticoagulants has been achieved is because warfarin can have an initial procoagulant effect, particularly in patients with protein C or protein S deficiencies, potentially causing fat necrosis.

For patients whose treatment has included thrombolysis for acute, massive PE causing hemodynamic instability, heparin infusion should be started once the thrombin time (TT) or aPTT is less than twice the baseline value. Treatment with an oral coumarin derivative should begin after 24-48 hours of consistent anticoagulation.

Appropriate anticoagulation with the oral medication has been accomplished when the INR is between 2.0 and 3.0.

Once the INR is consistently within the desired range, treatment can continue in the outpatient setting as long as no other concomitant conditions are present that require continued inpatient treatment.

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